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Muntner P, Shimbo D, Carey RM, Charleston JB, Gaillard T, Misra S, Myers MG, Ogedegbe G, Schwartz JE, Townsend RR, Urbina EM, Viera AJ, White WB, Wright JT. Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. Hypertension 2019; 73:e35-e66. [PMID: 30827125 DOI: 10.1161/hyp.0000000000000087] [Citation(s) in RCA: 622] [Impact Index Per Article: 124.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. This article provides an updated American Heart Association scientific statement on BP measurement in humans. In the office setting, many oscillometric devices have been validated that allow accurate BP measurement while reducing human errors associated with the auscultatory approach. Fully automated oscillometric devices capable of taking multiple readings even without an observer being present may provide a more accurate measurement of BP than auscultation. Studies have shown substantial differences in BP when measured outside versus in the office setting. Ambulatory BP monitoring is considered the reference standard for out-of-office BP assessment, with home BP monitoring being an alternative when ambulatory BP monitoring is not available or tolerated. Compared with their counterparts with sustained normotension (ie, nonhypertensive BP levels in and outside the office setting), it is unclear whether adults with white-coat hypertension (ie, hypertensive BP levels in the office but not outside the office) have increased cardiovascular disease risk, whereas those with masked hypertension (ie, hypertensive BP levels outside the office but not in the office) are at substantially increased risk. In addition, high nighttime BP on ambulatory BP monitoring is associated with increased cardiovascular disease risk. Both oscillometric and auscultatory methods are considered acceptable for measuring BP in children and adolescents. Regardless of the method used to measure BP, initial and ongoing training of technicians and healthcare providers and the use of validated and calibrated devices are critical for obtaining accurate BP measurements.
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Bello NA, Woolley JJ, Cleary KL, Falzon L, Alpert BS, Oparil S, Cutter G, Wapner R, Muntner P, Tita AT, Shimbo D. Accuracy of Blood Pressure Measurement Devices in Pregnancy: A Systematic Review of Validation Studies. Hypertension 2017; 71:326-335. [PMID: 29229741 DOI: 10.1161/hypertensionaha.117.10295] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/03/2017] [Accepted: 11/16/2017] [Indexed: 11/16/2022]
Abstract
The accurate measurement of blood pressure (BP) in pregnancy is essential to guide medical decision making that affects both mother and fetus. The aim of this systematic review was to determine the accuracy of ambulatory, home, and clinic BP measurement devices in pregnant women. We searched Ovid MEDLINE, The Cochrane Library, EMBASE, CINAHL EBSCO, ClinicalTrials.gov, International Clinical Trials Registry Platform, and dabl from inception through August 3, 2017 for articles that assessed the validity of an upper arm BP measurement device against a mercury sphygmomanometer in pregnant women. Two independent investigators determined eligibility, extracted data, and adjudicated protocol violations. From 1798 potential articles identified, 41, that assessed 28 devices, met the inclusion criteria. Most articles (n=32) followed a standard or modified American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization, British Hypertension Society, or European Society of Hypertension validation protocol. Several articles described the results of validation studies performed on >1 device (n=7) or in >1 population of pregnant women (n=12), comprising 64 pairwise validity assessments. The device was validated in 61% (32 of 52) of studies which used a standard or modified protocol. Only 34% (11 of 32) of the studies wherein the device was successfully validated were performed without a protocol violation. Given the implications of inaccurate BP measurement in pregnant women, healthcare providers should be aware of and try to use the BP measurement devices which have been properly validated in this population.
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Affiliation(s)
- Natalie A Bello
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham.
| | - Jonathan J Woolley
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Kirsten Lawrence Cleary
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Louise Falzon
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Bruce S Alpert
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Suzanne Oparil
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Gary Cutter
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Ronald Wapner
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Paul Muntner
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Alan T Tita
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Daichi Shimbo
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
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Xu T, Zhang Y, Tan X. Estimate of nocturnal blood pressure and detection of non-dippers based on clinical or ambulatory monitoring in the inpatient setting. BMC Cardiovasc Disord 2013; 13:37. [PMID: 23692688 PMCID: PMC3665662 DOI: 10.1186/1471-2261-13-37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 05/17/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ambulatory blood pressure monitoring is regarded as the gold standard for monitoring nocturnal blood pressure (NBP) and is usually performed out of office. Currently, a novel method for monitoring NBP is indispensible in the inpatient setting. The widely used manual BP monitoring procedure has the potential to monitor NBP in the hospital setting. The feasibility and accuracy of manual sphygmomanometer to monitor NBP has not been explored widely. METHODS A cross-sectional study was conducted at the cardiology department of a university-affiliated hospital to study patients with mild-to-moderate essential hypertension. One hundred and fifty-five patients were recruited to compare BP derived from a manual device and ambulatory BP monitoring (ABPM). The manual BP measurement was performed six times at 22:00, 02:00, 06:00, 10:00, 14:00 and 18:00 h. The measurements at 22:00, 02:00 and 06:00 h were defined as night-time and the others as daytime. ABPM was programmed to measure at 30-min intervals between measurements. RESULTS All-day, daytime and night-time BP did not differ significantly from 24-h ambulatory systolic BP [all-day mean difference -0.52±4.67 mmHg, 95% confidence interval (CI) -1.26 to 0.22, P=0.168; daytime mean difference 0.24±5.45 mmHg, 95% CI -0.62 to 1.11, P=0.580; night-time mean difference 0.30±7.22 mmHg, 95% CI -0.84 to 1.45, P=0.601) rather than diastolic BP. There was a strong correlation between clinical and ambulatory BP for both systolic and diastolic BP. On the basis of ABPM, 101 (65%) patients were classified as non-dippers, compared with 106 (68%) by manual sphygmomanometer (P<0.001). CONCLUSIONS Traditional manual sphygmomanometer provides similar daytime and night-time systolic BP measurements in hospital. Moreover, the detection of non-dippers by manual methods is in good agreement with 24-h ABPM. Further studies are required to confirm the clinical relevance of these findings by comparing the association of NBP in the hospital ward assessed by manual monitoring with preclinical organ damage and cardiovascular and cerebrovascular outcomes.
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Affiliation(s)
- Tan Xu
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, China
| | - Yongqing Zhang
- Department of Cardiology, Peoples’ Hospital of SanYan, SanYan, Hainan 572000, China
| | - Xuerui Tan
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, China
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Langenegger E, Dalla S, Petro G, Hall D. Invasive versus non-invasive monitoring of acute severe hypertension in women with pre-eclampsia. Pregnancy Hypertens 2012; 2:374-9. [PMID: 26105606 DOI: 10.1016/j.preghy.2012.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 01/24/2012] [Accepted: 01/31/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the accuracy of two non-invasive methods of blood-pressure measurement with intra-arterial measurement in women with pre-eclampsia and acute severe hypertension. METHODS This descriptive, cross-sectional study prospectively enrolled 23 women with pre-eclampsia and acute severe hypertension for continuous intra-arterial blood-pressure monitoring. Simultaneous monitoring was performed with a manual and an automated, non-invasive device during episodes of severe hypertension. The paired T-test was used to compare measured values. The accuracy of a MAP⩾125mmHg in detecting a systolic blood pressure⩾160mmHg was determined. RESULTS There was a weak correlation between intra-arterial and automated as well as intra-arterial and manual systolic values (r=0.34, p<0.01; r=0.41, p<0.00, respectively). Better correlation was found amongst diastolic values. The differences between the mean intra-arterial (94±11mmHg) and automated (96±12mmHg) diastolic values as well as intra-arterial and manual diastolic measurements (94±14mmHg) were not significant (p=0.20, 0.65, respectively). A mean arterial pressure⩾125mmHg was not accurate in detecting a systolic value⩾160mmHg, with low sensitivities (17.2-35.9%) and specificities (0-50%) for all three methods. CONCLUSIONS When compared to intra-arterial monitoring, the automated and manual methods showed weak correlation with systolic but better correlation with diastolic values. A mean arterial pressure⩾125mmHg was not accurate in detecting systolic peaks. When protection against cerebral haemorrhage is paramount, intra-arterial measurement of systolic values is best.
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Affiliation(s)
- E Langenegger
- Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Academic Hospital, South Africa.
| | - S Dalla
- Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Academic Hospital, South Africa
| | - G Petro
- Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Academic Hospital, South Africa
| | - D Hall
- Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Academic Hospital, South Africa
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